Faculty/Presenter Disclosure
Slide 1
• Faculty: [Speaker’s name]
• Relationships with commercial interests:
– Grants/Research Support:
PharmaCorp ABC
– Speakers Bureau/Honoraria: XYZ
Biopharmaceuticals Ltd.
– Consulting Fees: MedX Group Inc.
– Other: Employee of XXY Hospital
Group
Disclosure of Commercial
Support
Slide 2
• This program has received financial support from
[organization name] in the form of [describe support
here – e.g. an educational grant].
• This program has received in-kind support from
[organization name] in the form of [describe support
here – e.g. logistical support].
• Potential for conflict(s) of interest:
 [Speaker/Faculty name] has received
[payment/funding, etc.] from [organization supporting
this program AND/OR organization whose product(s)
are being discussed in this program].
 [Supporting organization name]
[developed/licenses/distributes/benefits from the sale
of, etc.] a product that will be discussed in this
program: [insert generic and brand name here].
Mitigating Potential Bias
Slide 3
• [Explain how potential sources of
bias identified in slides 1 and 2
have been mitigated].